title: Surgical treatment options in patients with impaired bone quality.
abstract: BACKGROUND
  Bone quality should play an important role in decision-making for orthopaedic treatment options, implant selection, and affect ultimate surgical outcomes. The development of decision-making tools, currently typified by clinical guidelines, is highly dependent on the precise definition of the term(s) and the appropriate design of basic and clinical studies. This review was performed to determine the extent to which the issue of bone quality has been subjected to this type of process.
  
  
  OBJECTIVE
  We address the following issues: (1) current methods of clinically assessing bone quality; (2) emerging technologies; (3) how bone quality connects with surgical decision-making and the ultimate surgical outcome; and (4) gaps in knowledge that need to be closed to better characterize bone quality for more relevance to clinical decision-making.
  
  
  METHODS
  PubMed was used to identify selected papers relevant to our discussion. Additional sources were found using the references cited by identified papers.
  
  
  RESULTS
  Bone mineral density remains the most commonly validated clinical reference; however, it has had limited specificity for surgical decision-making. Other structural and geometric measures have not yet received enough study to provide definitive clinical applicability. A major gap remains between the basic research agenda for understanding bone quality and the transfer of these concepts to evidence-based practice.
  
  
  CONCLUSIONS
  Basic bone quality needs better definition through the systematic study of emerging technologies that offer a more precise clinical characterization of bone. Collaboration between basic scientists and clinicians needs to improve to facilitate the development of key questions for sound clinical studies.
authors.affiliation: Department of Orthopaedic Surgery, Drexel University College of Medicine, 245 N 15th Street, MS 420, Philadelphia, PA 19102, USA. Norman.Johanson@drexelmed.edu
authors.forename: Norman A
authors.initials: NA
authors.lastname: Johanson
authors.forename: Jody
authors.initials: J
authors.lastname: Litrenta
authors.forename: Jay M
authors.initials: JM
authors.lastname: Zampini
authors.forename: Frederic
authors.initials: F
authors.lastname: Kleinbart
authors.forename: Haviva M
authors.initials: HM
authors.lastname: Goldman
mesh_terms: D015502:Absorptiometry, Photon; D000077:Acetabulum / Q000503:physiopathology; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015519:Bone Density; D001847:Bone Diseases / Q000503:physiopathology / Q000601:surgery*; D001842:Bone and Bones / Q000503:physiopathology*; D005265:Femoral Neck Fractures / Q000601:surgery; D005593:Fracture Fixation, Internal; D019637:Orthopedic Procedures; D057068:Periprosthetic Fractures / Q000601:surgery; D012086:Reoperation; D000070636:Rotator Cuff Injuries; D013122:Spinal Diseases / Q000601:surgery